Professor Anthony McCarthy:

In the hospital, there is no particular time at which this might happen. People can be referred at five weeks into their pregnancy. Some women who come to the antenatal clinic are asked some woolly questions, which may be an opportunity to raise such issues. Their weight will be taken. Many women with eating disorders have excessive vomiting during pregnancy. Unfortunately, vomiting is a very normal part of pregnancy for lots of women and they often have different patterns of vomiting. When somebody presents with vomiting, people are thinking about weight issues. It sometimes depends on the woman coming forth with the issue and, very often, women with eating disorders have recovered to become pregnant. Many will have recovered to a certain extent, which is how they are able to get pregnant. Those with severe anorexia cannot get pregnant because ovarian function switches off.

For many, there is an opportunity for such issues to be raised and they start to worry about that. They may admit they are taking laxatives. They might begin to talk about it or sometimes we or the dieticians pick it up. We cannot say we always pick it up but we often do. The women are then referred to us. We have a number of patients we are seeing who are also, for instance, seeing eating disorder teams elsewhere. It comes up in all sorts of different ways. The Deputy raised a question as to whether there is a direct pathway for that. The system certainly could be improved but the issues involved present the same difficulties as with every issue. The Deputy mentioned a lot in her contribution. As she was describing all the different issues, whether disability, poverty or eating disorders, it came to my mind that we are constantly dealing with the tapestry of everybody's life.

Pregnancy brings up everything. It is a key moment when one's personal, body and relationship history and personal, mental health, physical and social difficulties all come together and coalesce. It is up to us as a service to be as good as we can at picking that up and then channelling the person towards medical social workers if it is a poverty or housing issue or towards the dieticians, whatever it might be, with all of us working together, I hope.